In the care of older persons with Alzheimer's Disease and related dementias (AD), severe disruptive behaviors (DBs) occur most commonly during assistance with activities of daily living. For caregivers, bathing is one of the most problematic of these activities. The proposed project will address disruptive behavior during bathing by studying this common problem in a population with an unusually high prevalence of DBs: older persons who have been committed to a state psychiatric facility with a primary diagnosis of AD. The proposed research is a collaborative effort between the University of North Carolina, Duke University, and John Umstead Hospital (JUH). JUH admits over 80 elderly persons (over one-third of which are African-American) with dementia and DBs annually and has recently created a dedicated dementia unit. Our definition of disruptive behaviors (DBs) includes resistiveness to care, agitation, verbal aggressiveness, and physical aggressiveness. This project aims: 1) to improve our understanding and measurement of DBs during bathing; 2) to develop a behavioral intervention that reduces such behaviors, enhances completion of bathing tasks with maximal self-care, and is accepted by staff; and 3) to conduct a preliminary randomized clinical trial of that intervention among geriatric patients with AD. Phase one, which will take place on the dementia unit at JUH, will: a) refine direct (video) observation measures of DBs during bathing, of completion of bathing tasks, and of caregiving behaviors during bathing and b) identify factors related to the patient, the physical environment, and the bathing routine that lead to DBs during bathing. Phase two, which will also take place on the JUH dementia unit, will develop a multidimensional therapeutic approach to bathing these patients, that combines general and patient-specific strategies and focuses on education of existing staff. Phase three, which will take place on two general adult wards at JUH, will be a randomized clinical trial of adequate numbers to yield preliminary results and to pave the way for a larger randomized trial. The results of these studies should yield information useful to the sizeable population of state hospital residents with AD; they may also be generalizable to all AD patients who present problems during bathing.